A Link Between Mental Health And Mass Violence?

Earlier we talked with Dr. Carl Bell. He is a psychiatrist and a professor at the University of Illinois. He's the president and CEO of the Community Mental Health Council in Chicago, Illinois, and we've spoken with him on a number of occasions about issues in mental health, but he has a particular interest in the issue of violence. In fact, he's the founder of the Institute for the Prevention of Violence, has done extensive research in this area, and we caught up with him on Tuesday.

Welcome back to the program. Thanks so much for speaking with us once again.

CARL BELL: Thank you. Always a pleasure.

MARTIN: You know, I think people have two reactions to something like what happened on Sunday. They'll say this guy is evil, or they'll say this person must be mentally ill. Or they'll say both things, but you've told us in the past that the kneejerk reaction that people who do these kinds of things are all mentally ill is just wrong. Could you tell us more about why you say that?

BELL: Well, you know, there are various types of violence that have various motivations. You have the people who perpetrate a mass murder before they commit suicide to make as huge a statement as possible. You have people who are completely and totally in their right mind, have all their faculties, and they are trying to do the martyrdom thing where they make a political statement. You've got people who are mentally ill who kill. You've got people who do hate crime violence. There are a lot of different reasons for violence, so violence is not one thing.

MARTIN: We just spoke with Mark Potok of the Southern Poverty Law Center and we talked about Wade Michael Page's involvement with these white supremacist groups, and I know you've done research in this area and I know it's a complicated question, but you do wonder whether extreme racist ideology is that connected to mental illness.

BELL: Well, you know, there are these things called personality disorders, and one of them is a narcissistic personality disorder, but it doesn't really reach the criteria of a person being insane or psychotic or clinically treatable, necessarily. And so I've always thought that people who engage in these sort of racist behaviors have been very much aligned and overlapped with what's called a narcissistic personality disorder, where you're trying to make a political statement by killing a whole bunch of people and you have absolutely no compassion or empathy or consideration because you want to make some kind of a statement. How much more narcissistic can you be?

MARTIN: Let me ask something that Mark Potok just told us. I mean it's been reported that Wade Michael Page had had a lot of interpersonal problems, you know, leading up to this, that he - you know, he was separated from the military. That was quite some time ago. The reports are now that it was related to drinking and conduct. Our sources are telling us that it was not related to bias-related issues, but he'd also had a number of setbacks.

He recently lost his job. He lost his home, and that he lost his girlfriend. You know, a lot of people are suffering setbacks like this right now, but they don't become violent. And I'm just wondering, in the course of, you know, your work with people who have become violent or who've been victimized or traumatized by violence, is there a thread there where setbacks are involved? Is that a common trigger to something like this?

BELL: Well, it's certainly a risk factor. If you've been down on your luck, if everything's going wrong, that certainly makes you want to do what most people do when they're in a crisis situation, which is to do something dumb and ignorant and make things worse, because that's what people do when they get under stress. They become anxious and they make their situations worse as opposed to doing a counter-intuitive thing, which is to relax.

So that there are people - all kinds of people are close to the edge, as the song used to say, but because they have a sense of self, because they have a sense of purpose, because they have people who are supporting them, because they know the difference between right and wrong, because they have empathy for other people, they don't do these kinds of things.

MARTIN: We're talking about the role of mental illness in these recent mass shootings that we've been covering. We're speaking with psychiatrist and University of Illinois Professor Dr. Carl Bell. He's also the president and CEO of the Community Mental Health Council and founder of the Institute for the Prevention of Violence.

Not long ago we spoke with you about that shooting three weeks ago at the movie theater in Aurora, Colorado. And in that case it emerged that the shooter, James Holmes, had been seeing a mental health specialist during his time at the University of Colorado.

BELL: Right.

MARTIN: And that was before he dropped out, a couple of weeks prior to the shooting itself. And I just wanted to ask about that. I mean, the fact that he took the step - whatever caused him to take the step to see a specialist, a mental health professional, but then to walk away from it, you know, evidently - and I wanted to ask, is there anything we can learn from this?

BELL: Well, you know, people are always ambivalent about getting help. People are extraordinarily ambivalent towards psychiatrists. Most people tend to paint us with the same brush that they paint our patients, that everybody in that room is mentally ill. And so there's always this ambivalence that people have about letting somebody into their personal private mind and thoughts, so it's very difficult to submit, if you will, and to open yourself up for help.

If you are, in fact, seriously mentally ill, it's even more difficult because you're not exactly in touch with reality or things, and so it makes it even more difficult to form a relationship and to follow through.

It's extraordinarily challenging, especially for the colleges, to be dealing with all of these people who are in their midst who are actually seriously mentally ill, because most colleges are not prepared for seriously mentally ill people to be in their midst. They're used to people with minor issues, and so most of the counseling you get are from guidance counseling people as opposed to psychiatrists who can prescribe medication.

MARTIN: Is there something, though, that friends, neighbors, people who are connected to people could be doing in a situation like this, where somebody is having difficulty, who is on edge? It is one of these breaking points.

BELL: You know, the last year we did - I talked about the whole issue of monitoring and I noticed on one of the blogs that one of the listeners said, oh, you're suggesting that the FBI track people and monitor people. And that's not what I was suggesting at all. I was actually suggesting that the natural support systems - family, friends, colleagues - look after people.

You know, we're in a civilized society where people are actually supposed to be connected to one another and look after one another.

MARTIN: So you're suggesting that that kind of connectedness doesn't have to necessarily be with mental health specialists, although that is helpful and important. You're just saying just the connectedness of presence can be helpful.

BELL: Exactly, exactly. Now, let's be clear though. If you are seriously, chronically, persistently mentally ill, the support is certainly welcome, it's certainly helpful, but you also need some serious professional treatment. If, on the other hand, you simply have what most people refer to as issues - and, you know, everybody got issues - then, you know, having family support, church, club support, activities, bowling, whatever it is, is very helpful because it releases the aloneness. It releases the sense of, gee, what am I here for? You've got support, you've got family, you've got friends, you've got colleagues.

And oftentimes that in and of itself, assuming you have some social skills and you've been properly raised, it protects you from these things. The difficulty is that my experience with people who do these kinds of mass murders - they sort of treat people like plants. You know, it's OK to water a plant whenever you want to. It's OK to pull a leaf off a tree because the tree is not screaming and hollering.

And unfortunately, a lot of the people that I've talked to who do these kinds of crimes treat people like they're plants, because they don't have any empathy. They don't have any compassion. They don't know the human connection or the human relationship, which is why we have been trying nationally to increase the nurse/home visitation programs so that mothers and infants can bond so that infants growing up and people growing up can know compassion, can know empathy, so they don't go out and just treat somebody like they're a tree and pull off a couple of leaves.

MARTIN: Before we let you go, there is one thing that connects a number of the cases that we've been talking about so far, and by using the word cases, I don't mean to minimize just how, you know, devastating all these experiences have been.

BELL: Sure.

MARTIN: But one thing that does connect them - all these people are men. That's...

BELL: Yeah.

MARTIN: That's one thing that they all have in common. I mean, whether the person who committed that terrible mass shooting at Virginia Tech, who was Korean-American, then, you know, Jared Loughner, one case that we spoke about, you know, some years ago, Buford Furrow, who attacked these...

BELL: Yes.

MARTIN: ...you know, men, women and children at a Jewish community center in Los Angeles. They're all men, and I'm sorry. I can't help but notice that and I just wonder - what about that?

BELL: Astute observation. There's a professor of psychiatry, public health and education at Harvard, Justin Pierce, who's retired now, who used to talk about male entitlement dysfunction. And what he meant by that is that men are - you know, we've got testosterone disease. You know, we're aggressive. We're competitive. We actually believe that we own our wives, we own our children. Some of us actually believe that we could actually own other people and get away with it.

And so, you know, men have these issues that are colloquially referred to - it's not a formal psychiatric diagnosis, but male entitlement dysfunction is a problem and women know that men have male entitlement dysfunction. I'm recovering, actually, myself, but the challenge is, is that - you know who raises men? It's women.

So it's an interesting dynamic of how do you teach men to not be aggressive, competitive, 'cause(ph) - to be warriors. You know, I mean, that's kind of our role in this society and in most other cultures, although there are some exceptions. And so we've got to do a much better job at connecting men to their softer sides.

MARTIN: Dr. Carl Bell is a psychiatrist and professor at the University of Illinois. He's the president and CEO of the Community Mental Health Council in Chicago and the founder of the Institute for the Prevention of Violence, and he was kind enough to join us from member station WBEZ in Chicago.